Axillary Clearance Following Positive Sentinel Lymph Node Biopsy in Symptomatic Breast Cancer

Overview

Journal In Vivo

Specialty Oncology

Date 2020 Nov 4

PMID 33144460

Citations 2

Authors

Hudhaifah Shaker

Zeinab Mahate

Grit Dabritz

Mohammed S Absar

Affiliations

Soon will be listed here.

Abstract

Background/aim: Symptomatic cancers display a different biological behaviour from screen-detected cancers, which may impact the management of axillary metastases. We aimed to determine the role of unselected axillary nodal clearance (ANC) in symptomatic patients with positive sentinel node biopsies (SNBs).

Patients And Methods: A case-note review was performed on 95 symptomatic breast cancer patients who underwent ANC following positive SNB.

Results: Thirty-eight (40%) patients were treated with a mastectomy and 57 (60%) with breast-conserving surgery. At ANC, 25 patients (26.3%) showed evidence of further lymph node metastases, with 15 (60%) having two or fewer macrometastases. The presence of more than 2 SNB macrometastases was associated with further ANC metastases (p<0.001). The presence of further metastases at ANC was not associated with either reduced overall survival or disease-free survival.

Conclusion: A number of symptomatic breast cancer patients with positive SNBs may be overtreated. Ongoing trials examining the management of low volume SNB macrometastases need to consider the symptomatic subgroup in their conclusions.

Citing Articles

Management of the Axilla After Neoadjuvant Chemotherapy: Can Axillary Needle Biopsy Replace Sentinel Node Biopsy?.

Yildirim E, Basim P, Ucar N, Bektas S, Iscen K, Karci E In Vivo. 2024; 38(5):2523-2530.

PMID: 39187354 PMC: 11363797. DOI: 10.21873/invivo.13724.

Polymer Nanoparticles and Nanomotors Modified by DNA/RNA Aptamers and Antibodies in Targeted Therapy of Cancer.

Subjakova V, Oravczova V, Hianik T Polymers (Basel). 2021; 13(3).

PMID: 33494545 PMC: 7866063. DOI: 10.3390/polym13030341.

References

Goyal A, Dodwell D . POSNOC: A Randomised Trial Looking at Axillary Treatment in Women with One or Two Sentinel Nodes with Macrometastases. Clin Oncol (R Coll Radiol). 2015; 27(12):692-5. DOI: 10.1016/j.clon.2015.07.005. View

Hamdan D, Nguyen T, Leboeuf C, Meles S, Janin A, Bousquet G . Genomics applied to the treatment of breast cancer. Oncotarget. 2019; 10(46):4786-4801. PMC: 6677666. DOI: 10.18632/oncotarget.27102. View

Savolt A, Peley G, Polgar C, Udvarhelyi N, Rubovszky G, Kovacs E . Eight-year follow up result of the OTOASOR trial: The Optimal Treatment Of the Axilla - Surgery Or Radiotherapy after positive sentinel lymph node biopsy in early-stage breast cancer: A randomized, single centre, phase III, non-inferiority trial. Eur J Surg Oncol. 2017; 43(4):672-679. DOI: 10.1016/j.ejso.2016.12.011. View

Grabau D, Dihge L, Ferno M, Ingvar C, Ryden L . Completion axillary dissection can safely be omitted in screen detected breast cancer patients with micrometastases. A decade's experience from a single institution. Eur J Surg Oncol. 2013; 39(6):601-7. DOI: 10.1016/j.ejso.2013.03.012. View

Farshid G, Pradhan M, Kollias J, Gill P . A decision aid for predicting non-sentinel node involvement in women with breast cancer and at least one positive sentinel node. Breast. 2004; 13(6):494-501. DOI: 10.1016/j.breast.2004.08.005. View

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V . A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003; 349(6):546-53. DOI: 10.1056/NEJMoa012782. View

Goyal A, Dodwell D, Reed M, Coleman R . Axillary treatment in women with one or two sentinel nodes with macrometastases: more evidence is needed to inform practice. J Clin Oncol. 2014; 32(34):3902. DOI: 10.1200/JCO.2014.57.3717. View

Matikas A, Foukakis T, Swain S, Bergh J . Avoiding over- and undertreatment in patients with resected node-positive breast cancer with the use of gene expression signatures: are we there yet?. Ann Oncol. 2019; 30(7):1044-1050. PMC: 6695578. DOI: 10.1093/annonc/mdz126. View

Morrow M, Van Zee K, Patil S, Petruolo O, Mamtani A, Barrio A . Axillary Dissection and Nodal Irradiation Can Be Avoided for Most Node-positive Z0011-eligible Breast Cancers: A Prospective Validation Study of 793 Patients. Ann Surg. 2017; 266(3):457-462. PMC: 5649371. DOI: 10.1097/SLA.0000000000002354. View

10.

Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S . Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6:vi7-23. DOI: 10.1093/annonc/mdt284. View

11.

Gill P, Farshid G, Luke C, Roder D . Detection by screening mammography is a powerful independent predictor of survival in women diagnosed with breast cancer. Breast. 2004; 13(1):15-22. DOI: 10.1016/S0960-9776(03)00169-3. View

12.

Allgood P, Duffy S, Kearins O, OSullivan E, Tappenden N, Wallis M . Explaining the difference in prognosis between screen-detected and symptomatic breast cancers. Br J Cancer. 2011; 104(11):1680-5. PMC: 3111158. DOI: 10.1038/bjc.2011.144. View

13.

Yan M, Abdi M, Falkson C . Axillary Management in Breast Cancer Patients: A Comprehensive Review of the Key Trials. Clin Breast Cancer. 2018; 18(6):e1251-e1259. DOI: 10.1016/j.clbc.2018.08.002. View

14.

Fu Y, Chung D, Cao M, Apple S, Chang H . Is axillary lymph node dissection necessary after sentinel lymph node biopsy in patients with mastectomy and pathological N1 breast cancer?. Ann Surg Oncol. 2014; 21(13):4109-23. DOI: 10.1245/s10434-014-3814-3. View

15.

Tvedskov T, Jensen M, Balslev E, Garne J, Vejborg I, Christiansen P . Risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected breast cancers. Acta Oncol. 2015; 55(4):455-9. DOI: 10.3109/0284186X.2015.1094186. View

16.

Giuliano A, Hunt K, Ballman K, Beitsch P, Whitworth P, Blumencranz P . Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011; 305(6):569-75. PMC: 5389857. DOI: 10.1001/jama.2011.90. View

17.

Ahmed M, Jozsa F, Baker R, Rubio I, Benson J, Douek M . Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients. Breast Cancer Res Treat. 2017; 166(2):329-336. PMC: 5668351. DOI: 10.1007/s10549-017-4405-3. View

18.

Morrow M, Jagsi R, McLeod M, Shumway D, Katz S . Surgeon Attitudes Toward the Omission of Axillary Dissection in Early Breast Cancer. JAMA Oncol. 2018; 4(11):1511-1516. PMC: 6248076. DOI: 10.1001/jamaoncol.2018.1908. View

19.

Donker M, van Tienhoven G, Straver M, Meijnen P, van de Velde C, Mansel R . Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014; 15(12):1303-10. PMC: 4291166. DOI: 10.1016/S1470-2045(14)70460-7. View

20.

Gera R, Kasem A, Mokbel K . Can Complete Axillary Node Dissection Be Safely Omitted in Patients with Early Breast Cancer When the Sentinel Node Biopsy Is Positive for Malignancy? An Update for Clinical Practice. In Vivo. 2018; 32(6):1301-1307. PMC: 6365714. DOI: 10.21873/invivo.11380. View